1. Date of content:
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2. Patient Abuse – Tennessee Version
Effective Date: October 2014
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3. Abuse Overview There are many forms of abuse in our society today.
Abuse reaches all social and economic levels, touches all age groups, and can pass from generation to generation. 
Caregivers must be able to identify victims of abuse.
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4. Abuse and Neglect
Abuse (physical, sexual, and emotional) generally involves forms of harm including but not limited to, the infliction of physical pain, injury, mental anguish, or the deprivation of service by a caretaker that are necessary to maintain the health and welfare of an adult or a situation in which an adult is unable to provide or obtain the services that are necessary to maintain that person's health or welfare. Neglect may be unintentional, resulting from the caregiver's lack of ability to provide or arrange for the care or services the adult requires. Neglect also may be due to the intentional failure of the caregiver to meet the adult's needs.
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5. Exploitation
Exploitation is the improper use by a caretaker of funds that have been paid by a governmental agency to an adult or the caretaker for the use or care of the adult.
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6. Recognizing Physical Abuse
Some injuries may be hidden or explained by an unlikely story. 
Bruising may occur on both limbs. 
Multiple bruises may occur in different stages of healing. 
Bruising may occur in patterns. 
The explanation of the injury does not match the injury.
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7. Behaviors related to Abuse
The abuser may be overprotective, hover around the victim, speak for the victim, and/or be aggressive if challenged. The victim may be quiet and submissive and/or have marked personality changes when the abuser is near.
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8. Sexual Abuse
Sexual abuse is when an adult is forced, tricked, threatened or otherwise coerced by a person into sexual activity, involuntary exposure to sexually explicit material or language, or sexual contact against such adult's will. Sexual abuse also occurs when an adult is unable to give consent to such sexual activities or contact and is engaged in such activities or contact with another person.
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9. Signs of Sexual Abuse Signs of sexual abuse may include the following:
A sudden change in behavior 
Difficulty trusting others 
An unwillingness to share problems with others 
A fear of being scolded or embarrassed 
A noticeable need to "belong"   
A fear of not being likeable
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10. Suspected Abuse Occurring within an MSHA facility
Reporting: The MSHA team member having knowledge of or a reasonable belief that abuse has occurred while a patient is in an MSHA facility must report concerns immediately to Adult Protective Services (APS). Any allegation, observation, or suspected case of abuse that occurs while a patient is in an MSHA facility should be reported immediately to the team member's supervisor and to the Risk Manager. Notification of the team member's supervisor is not a substitute for the team member fulfilling his/her responsibility to notify APS directly.
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11. Suspected Abuse Occurring within an MSHA facility
If the suspected abuse includes abuse involving criminal sexual offense, the team member shall report such suspected abuse to the local law enforcement agency in the jurisdiction where the suspected offense occurred. The team member shall notify the attending physician and social work of the suspected abuse.
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12. Suspected Abuse Occurring within an MSHA facility
The team member shall complete a Patient Safety Report. If the incident involves an MSHA team member, the supervisor receiving the report will notify the Human Resources Department.
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13. Suspected Abuse Occurring Outside an MSHA facility
Reporting: The MSHA team member having knowledge of or a reasonable belief that an adult suffers from abuse must report concerns immediately to Adult Protective Services (APS). The team member shall also notify his/her supervisor of the suspected abuse. Notification of the team member's supervisor is not a substitute for the team member fulfilling his/her responsibility to notify APS directly.
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14. Suspected Abuse Occurring Outside an MSHA facility
If the suspected abuse includes abuse involving criminal sexual offense, the team member shall report such suspected abuse to the local law enforcement agency in the jurisdiction where the suspected offense occurred. 
The team member shall notify the attending physician and social work of the suspected abuse.
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15. Failure to Comply with Reporting Requirements
Failure to comply with reporting requirements may result in disciplinary action. 
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16. Child Abuse Reporting - TN
The Tennessee Department of Children's Services, Division of Child Safety:
Accepts all reports of alleged child abuse and neglect.
Screens the report to determine if the situation requires an investigation.
Conducts investigation of child abuse and neglect.
Makes decisions to keep children safe in the least restrictive setting. 
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17. Who is Mandated to Report?
Any person who has knowledge of, or suspects abuse or neglect of a child must report it. 
The law makes no distinction between professionals and non-professionals on the issue of reporting.
TCA (a)(1) Any person who has knowledge of or is called upon to render aid to any child who is suffering from or has sustained any wound, injury, disability, or physical or mental condition shall report such harm is of such a nature as to reasonably indicate that it has been caused by brutality, abuse or neglect or that, on the basis of available information, reasonably appears to have been caused by brutality, abuse or neglect.
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18. Where Can You Report Child Abuse?
The law states there are four choices:
Juvenile Court 
Department of Children's Services(DCS) 
The Sheriff in the county where the child resides 
Chief law enforcement officer in the county where the child resides.
TCA (a)(2) Any such person with knowledge of the type of harm described in this subsection shall report it, by telephone or otherwise, to the: Judge having juvenile jurisdiction over the child; Department, in a manner specified by the department, either by contacting a local representative of the department or by utilizing the department's centralized intake procedure, where applicable; Sheriff of the county where the child resides; or Chief law enforcement official of the municipality where the child resides.
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19. When is it appropriate to make a report?
What if I'm "Just concerned"? You do not have to prove that child abuse/neglect has occurred in order to report. The law speaks to making reports based on "available information" and in a situation that "reasonably appears to have been caused by brutality, abuse, or neglect."
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20. 2005 Changes to TN Law
TCA (b) Pertains to Organizations That Are Responsible for the Care of Children
This includes clinics, hospitals, schools, child care centers, and residential care facilities.
What's Unique About This Section of the Law? 
Before 2005, the (b) section of the law stated that schools and other institutions could require their staff to report alleged child abuse or neglect to the in charge of the organization (e.g. healthcare facility) or such person's designee who would make the official report of child abuse or neglect.
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21. What does the change mean?
Hospitals, clinics, schools, or any other organization responsible for the care of children may not develop their own internal reporting procedures. Individuals who work for these organizations and who have knowledge of suspected child abuse or neglect must report those concerns.
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22. Examples
If a child tells her nurse she is being abused, the nurse has the responsibility to make the report to the proper authorities. If a child is being seen for outpatient physical therapy tells his physical therapist he has been a victim of child abuse, the physical therapist is responsible for making the report.
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23. Do I have to tell MSHA when I report abuse?
Do these employees have an obligation to tell their employers they have made a report? Nothing in this section of the law prohibits hospitals, clinics, schools, or other organizations responsible for the care of the children from developing a specific procedure for internally tracking, investigating, reporting, or otherwise monitoring a report made by a member of its staff pursuant to this section, including requiring a member of its staff who makes such a report to provide a copy of or notice concerning such report to the organization, so long as such procedure does not inhibit, interfere with, or otherwise affect the duty of a person to make a report as required by subsection (a).
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24. What does this mean?
Organizations can develop internal procedures to track and monitor reports of child abuse and neglect made by their staff. 
The internal procedure must not inhibit or discourage staff from making reports as required by section (a) of the law.
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25. Failure to Report a Suspected Case of Child Abuse or Neglect
Is a class A misdemeanor. 
Under the old law the fine for "failure to report” was not to exceed $50.00. 
2005 law increases the limit of the fine to $2500.
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